Zeaxanthin Combination Therapy Effective for nAMD

R. Joseph Olk, MD

A combination therapy with zeaxanthin is medically effective and cost-effective compared to other treatment regimens for neovascular age-related macular degeneration.

The findings, presented at the American Society of Retina Specialists 2020 (ASRS 2020) Virtual Sessions, demonstrated the addition of oral zeaxanthin reduced the risk of subfoveal choroidal neovascularization development compared to other reported treatments.

R. Joseph Olk, MD, and a team of investigators aimed to determine if combination therapy of intravitreal bevacizumab, intravitreal and periocular steroids, photodynamic therapy with venteporfin, and oral zeaxanthin resulted in effective treatment of neovascular age-related macular degeneration compared to published monotherapy studies.

The investigators conducted a five-year, retrospective case-controlled consecutive series. They reviewed 445 eyes of 337 patients with subfoveal choroidal neovascularization secondary to neovascular age-related macular degeneration. Eyes were treated with reduced-fluence (25mJ) photodynamic therapy with verteporfin, intravitreal and periocular steroids, 20 mg of daily oral zeaxanthin, and 4 monthly injections of intravitreal bevacizumab.

Retreatment occurred in any eyes with persistent intraretinal or subretinal fluid on the optical coherence tomography or persistent leakage on fluorescein/indocyanine green angiography. The therapy cycles were repeated until the eyes were considered stable.

Olk and the team recorded the best corrected visual acuity and central foveal thickness on the optical coherence tomography at 3, 6, and 12 months, and 2, 3, 4, and 5 years follow-up.

Adherence to follow-up was high, with 99.8% at 1 year (435 eyes), 96.1% at 3 years (419 eyes), and 92.2% (402 eyes). There were 15 patients lost to follow-up during the study and 17 patients died.

At 5 years of follow up, 55% of eyes treated had either stable or improved visual acuity. Among the eyes, 13% gained at least 15 letters. The average number of treatment cycles to achieve eye stability was 2.7. Neovascular age-related macular degeneration was developed in 8.8% of fellow eyes at 1 year, 21.1% at 3 years, and 21.6% at 5 years.

The team conducted an average cost-utility analysis and learned the combination therapy was very cost effective. There was an average cost of $8000 per eye compared to $72,000 for monotherapy using ranibizumab and $40,600 for aflibercept.

Overall, the combination therapy was both comparatively effective and more cost-effective than previously published monotherapy studies. The team concluded less treatment was needed to achieve eye stability when using the combination therapy than reported studies.

“This significantly reduces the treatment burden for patients and doctors,” the study investigators wrote.

Adding oral zeaxanthin reduced the risk of neovascular age-related macular degeneration in the fellow eye compared to previously reported cases. Zeaxanthin’s protective effect was also greater with time. The four- and five-year conversions to neovascular age-related macular degeneration in fellow eyes were significantly less than those in previously published, long-term studies.

The study, “Combination Therapy With Zeaxanthin for the treatment of Neovascular Age-Related Macular Degeneration (nAMD),” was presented at ASRS 2020.